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6. Deactivation of LVAD support for myocardial recovery—surgical perspectives

Author

Nickel, Ian, Potapov, Evgenij, Sun, Benjamin, Zimpfer, Daniel, Koliopoulou, Antigone, Adachi, Iki, Anyanwu, Anelechi, Falk, Volkmar, Atluri, Pavan, Faerber, Gloria, Goldstein, Daniel, Yarboro, Leora, Slaughter, Mark S., Milano, Carmelo, Tsukashita, Masaki, D’Alessandro, David, Silvestry, Scott, Kirov, Hristo, Bommareddi, Swaroop, Lanmüller, Pia, Doenst, Torsten, and Selzman, Craig H.

Published
2024
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8. Outcome of patients supported with the HeartMate 3 after extracorporeal life support: On behalf of the Durable Mechanical Circulatory Support After Extracorporeal Life Support Study Group

Author

Saeed, Diyar, Stark, Christoffer, Otto, Wolfgang, Loforte, Antonio, Zimpfer, Daniel, Bernhardt, Alexander M., Potapov, Evgenij, Morshius, Michiel, Schibilsky, David, Albert, Alexander, Raweh, Ayman, Riebandt, Julia, Pappalardo, Federico, Attisani, Matteo, Rinaldi, Mauro, Haneya, Assad, Huenges, Katharina, Ramjankhan, Faiz, Jorde, Ulrich P., Lewin, Daniel, Jawad, Khalil, Aubin, Hug, Ayala, Rafael, Reichenspurner, Hermann, Lichtenberg, Artur, Borger, Michael, and Gummert, Jan

Published
2024
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12. A multicenter evaluation of external outflow graft obstruction with a fully magnetically levitated left ventricular assist device

Author

Wert, Leonhard, Stewart, Garrick C., Mehra, Mandeep R., Milwidsky, Assi, Jorde, Ulrich P., Goldstein, Daniel J., Selzman, Craig H., Stehlik, Josef, Alshamdin, Faisal D., Khaliel, Feras H., Gustafsson, Finn, Boschi, Silvia, Loforte, Antonio, Ajello, Silvia, Scandroglio, Anna M., Tučanová, Zuzana, Netuka, Ivan, Schlöglhofer, Thomas, Zimpfer, Daniel, Zijderhand, Casper F., Caliskan, Kadir, Dogan, Günes, Schmitto, Jan D., Maier, Sven, Schibilsky, David, Jawad, Khalil, Saeed, Diyar, Faerber, Gloria, Morshuis, Michiel, Hanuna, Maja, Müller, Christoph S., Mulzer, Johanna, Kempfert, Jörg, Falk, Volkmar, and Potapov, Evgenij V.

Published
2024
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13. HeartMate 3 Snoopy: Noninvasive cardiovascular diagnosis of patients with fully magnetically levitated blood pumps during echocardiographic speed ramp tests and Valsalva maneuvers

Author

Schlöglhofer, Thomas, Gross, Christoph, Abart, Theodor, Schaefer, Anne-Kristin, Marko, Christiane, Röhrich, Michael, Widhalm, Gregor, Kaufmann, Friedrich, Weigel, Ingo, Al Asadi, Hebe, Karner, Barbara, Riebandt, Julia, Wiedemann, Dominik, Laufer, Günther, Schima, Heinrich, and Zimpfer, Daniel

Published
2024
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16. Durable left ventricular assist devices following temporary circulatory support on a microaxial flow pump with and without extracorporeal life support

Author

Lewin, Daniel, Rojas, Sebastian V., Billion, Michael, Meyer, Anna L., Netuka, Ivan, Kooij, Janajade, Pieri, Marina, Loforte, Antonio, Szymanski, Mariusz K., Moeller, Christian H., Akhyari, Payam, Jawad, Khalil, Krasivskyi, Ihor, Schmack, Bastian, Färber, Gloria, Medina, Marta, Haneya, Assad, Zimpfer, Daniel, Nersesian, Gaik, Oezkur, Mehmet, Djordjevic, Ilija, Saeed, Diyar, Stein, Julia, Kraaijeveld, Adriaan O., Gustafsson, Finn, Scandroglio, Mara, Meyns, Bart, Hofmann, Steffen, Belohlavek, Jan, Gummert, Jan F., Lanmueller, Pia, Bernhardt, Alexander M., and Potapov, Evgenij V.

Published
2024
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17. Management of Adults With Anomalous Aortic Origin of the Coronary Arteries: State-of-the-Art Review

Author

Gaudino, Mario, Di Franco, Antonino, Arbustini, Eloisa, Bacha, Emile, Bates, Eric R., Cameron, Duke E., Cao, Davide, David, Tirone E., De Paulis, Ruggero, El-Hamamsy, Ismail, Farooqi, Kanwal M., Girardi, Leonard N., Gräni, Christoph, Kochav, Jonathan D., Molossi, Silvana, Puskas, John D., Rao, Sunil V., Sandner, Sigrid, Tatoulis, James, Truong, Quynh A., Weinsaft, Jonathan W., Zimpfer, Daniel, and Mery, Carlos M.

Published
2023
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19. The 2023 International Society for Heart and Lung Transplantation Guidelines for Mechanical Circulatory Support: A 10- Year Update

Author

Saeed, Diyar, Feldman, David, Banayosy, Aly El, Birks, Emma, Blume, Elizabeth, Cowger, Jennifer, Hayward, Christopher, Jorde, Ulrich, Kremer, Jamila, MacGowan, Guy, Maltais, Simon, Maybaum, Simon, Mehra, Mandeep, Shah, Keyur B., Mohacsi, Paul, Schweiger, Martin, Schroeder, Sarah E., Shah, Palak, Slepian, Marvin, Tops, Laurens F., Alvarez, Paulino, Arabia, Francisco, Aslam, Saima, Benson-Louis, Louis, IV, Birati, Edo, Buchholz, Holger W., Cedars, Ari, Christensen, Dawn, Ciarka, Agnieszka, Coglianese, Erin, Cogswell, Rebecca, Cook, Jennifer, Copeland, Jack, Costello, Jose Gonzalez, Drakos, Stavros G, Eghtesady, Pirooz, Elliot, Tonya, Estep, Jerry D., Eulert-Grehn, Jaime-Juergen, Fabrizio, De Rita, Garbade, Jens, Gelow, Jill, Guglin, Maya, Hernandez-Montfort, Jaime, Horstmanshof, Doug, John, Ranjit, Kanwar, Manreet, Khaliel, Feras, Kim, Gene, Kumar, Sachin, Lavee, Jacob, Leache, Marzia, Leprince, Pascal, Lim, Sern, Loforte, Antonio, Maly, Jiri, Najjar, Samer, Netuka, Ivan, Pamboukian, Salpy V., Patel, Snehal R, Pinney, Sean, Pluym, Christina Vander, Potapov, Evgenij, Robson, Desiree, Rochlani, Yogita, Russell, Stuart, Sandau, Kristin, Sandoval, Elena, Sayer, Gabriel, Schettle, Sarah, Schibilsky, David, Schlöglhofer, Thomas, Schmitto, Jan, Siddique, Aleem, Silvestry, Scott, Slaughter, Mark S, Sun, Benjamin, Takayama, Hiroo, Tedford, Ryan, Teuteberg, Jeffrey J., Ton, Van-Khue, Uriel, Nir, Vierecke, Juliane, Zimpfer, Daniel, and D'Alessandro, David

Published
2023
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22. Sex differences among patients receiving ticagrelor monotherapy or aspirin after coronary bypass surgery: A prespecified subgroup analysis of the TiCAB trial

Author

Grothusen, Christina, Cremer, Jochen, Attmann, Tim, Friedrich, Ivar, Oberhoffer, Martin, Knosalla, Christoph, Walther, Thomas, Wimmer-Greinecker, Gerhard, Siepe, Matthias, Grubitzsch, Herko, Joost, Alexander, Schaefer, Andreas, Misfeld, Martin, Laufer, Günther, Wiedemann, Dominik, Englberger, Lars, Hambrecht, Rainer, Sandner, Sigrid, Kastrati, Adnan, Niessner, Alexander, Böning, Andreas, Zeymer, Uwe, Conradi, Lenard, Danner, Bernhard, Zimpfer, Daniel, Färber, Gloria, Manville, Emely, Schunkert, Heribert, and von Scheidt, Moritz

Published
2023
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26. Right Ventricular Myxoma with a Papillary Muscular Origin.

Author

Osipenko, Kira, Angleitner, Philipp, Heinrich, Nikolaus, Zimpfer, Daniel, and Andreas, Martin

Subjects
RIGHT heart atrium, TRICUSPID valve, PAPILLARY muscles, MYXOMA, VALVES, HEART
Abstract

Cardiac myxomas in the right ventricle are a very rare condition. In this case report, we describe an exceptionally uncommon case involving a right ventricular cardiac myxoma, originating from a papillary muscle, extending to both the tricuspid valve and the right atrium. The valve was able to be repaired via artificial chorda implantation. [ABSTRACT FROM AUTHOR]

Published
2024
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28. Cerebral Protection Strategies in Aortic Arch Surgery—Past Developments, Current Evidence, and Future Innovation.

Author

Werner, Paul, Winter, Martin, Mahr, Stephané, Stelzmueller, Marie-Elisabeth, Zimpfer, Daniel, and Ehrlich, Marek

Subjects
THORACIC aorta, OPERATIVE surgery, SURGERY, AORTA, CEREBRAL arteries, TECHNOLOGICAL innovations, PERFUSION
Abstract

Surgery of the aortic arch remains a complex procedure, with neurological events such as stroke remaining its most dreaded complications. Changes in surgical technique and the continuous innovation in neuroprotective strategies have led to a significant decrease in cerebral and spinal events. Different modes of cerebral perfusion, varying grades of hypothermia, and a number of pharmacological strategies all aim to reduce hypoxic and ischemic cerebral injury, yet there is no evidence indicating the clear superiority of one method over another. While surgical results continue to improve, novel hybrid and interventional techniques are just entering the stage and the question of optimal neuroprotection remains up to date. Within this perspective statement, we want to shed light on the current evidence and controversies of cerebral protection in aortic arch surgery, as well as what is on the horizon in this fast-evolving field. We further present our institutional approach as a large tertiary aortic reference center. [ABSTRACT FROM AUTHOR]

Published
2024
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29. Decellularized aortic homografts versus mechanical composite grafts for aortic root replacement.

Author

Andreeva, Alexandra, Werner, Paul, Coti, Iuliana, Kocher, Alfred, Laufer, Guenther, Ehrlich, Marek, Zimpfer, Daniel, and Andreas, Martin

Subjects
YOUNG adults, HOMOGRAFTS, AORTA, THROMBOEMBOLISM, COHORT analysis
Abstract

OBJECTIVES Mechanical composite valve grafts (MCVGs) are the first-line therapy for aortic root replacement in young adults. Decellularized aortic homografts (DAH) present a promising novel alternative due to their lower thrombogenicity. We aimed to compare both treatment options regarding survival and valve-related adverse events. METHODS This study was designed as a single-centre retrospective cohort study including patients who underwent root replacement with MCVG or DAH between 2000 and 2022. Urgent or emergent procedures were excluded. RESULTS The study cohort included 289 patients (MCVG n  = 216, DAH n  = 73) with a mean age of 48.5 ± 12 years (MCVG 49 ± 12 years vs DAH 47 ± 11 years; P  = 0.23) and a median EuroScore II of 1.7% (1.2, 2.6). The 30-day mortality was 1% (n  = 3). Cumulative survival at 3 years was 99% for DAH and 94% for MCVG, respectively (P  = 0.15). Mean follow-up was 98.9 ± 72.7 months. Bleeding events (n  = 14, 6.5%) and thromboembolism (n  = 14, 6.5%) were only observed in the MCVG group (P  = 0.19 and 0.09, respectively). Four cases (5%) of moderate structural valve deterioration occurred, all in the DAH group (P  ≤ 0.001). The cumulative incidence of a composite end point of valve-related adverse events was significantly higher in the MCVG group (P  = 0.0295). CONCLUSIONS Aortic root replacement with MCVGs and decellularized aortic homografts showed low mortality in an elective setting. Patients in the homograft cohort demonstrated significantly higher freedom from valve-related adverse events. DAH present a promising treatment option for young patients requiring root replacement; however, data on long-term durability are needed. [ABSTRACT FROM AUTHOR]

Published
2024
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32. Stroke Complications in Patients Requiring Durable Mechanical Circulatory Support Systems After Extracorporeal Life Support

Author

Saeed, Diyar, Loforte, Antonio, Morshuis, Michiel, Schibilsky, David, Zimpfer, Daniel, Riebandt, Julia, Pappalardo, Federico, Attisani, Matteo, Rinaldi, Mauro, Haneya, Assad, Ramjankhan, Faiz, Donker, Dirk W., Jorde, Ulrich P., Pacini, Davide, Otto, Wolfgang, Stein, Julia, Lewin, Daniel, Jawad, Khalil, Wieloch, Radi, Ayala, Rafael, Cremer, Jochen, Borger, Michael A., Lichtenberg, Artur, Gummert, Jan, and Potapov, Evgenij

Published
2023
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35. Transition From Temporary to Durable Circulatory Support Systems

Author

Saeed, Diyar, Potapov, Evgenij, Loforte, Antonio, Morshuis, Michiel, Schibilsky, David, Zimpfer, Daniel, Riebandt, Julia, Pappalardo, Federico, Attisani, Matteo, Rinaldi, Mauro, Haneya, Assad, Ramjankhan, Faiz, Donker, Dirk W., Jorde, Ulrich P., Stein, Julia, Tsyganenko, Dmytro, Jawad, Khalil, Wieloch, Radi, Ayala, Rafael, Cremer, Jochen, Borger, Michael A., Lichtenberg, Artur, and Gummert, Jan

Published
2020
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38. Platelet inhibitor withdrawal and outcomes after coronary artery surgery: an individual patient data meta-analysis.

Author

Schoerghuber, Michael, Kuenzer, Thomas, Biancari, Fausto, Dalén, Magnus, Hansson, Emma C, Jeppsson, Anders, Schlachtenberger, Georg, Siegemund, Martin, Voetsch, Andreas, Pregartner, Gudrun, Lindenau, Ines, Zimpfer, Daniel, Berghold, Andrea, Mahla, Elisabeth, and Zirlik, Andreas

Subjects
CORONARY artery bypass, CORONARY artery surgery, ERYTHROCYTES, PLATELET aggregation inhibitors, CHEST tubes, RED blood cell transfusion
Abstract

OBJECTIVES To evaluate the association between guideline-conforming as compared to shorter than recommended withdrawal period of P2Y12 receptor inhibitors prior to isolated on-pump coronary artery bypass grafting (CABG) and the incidence of severe bleeding and ischaemic events. Randomized controlled trials are lacking in this field. METHODS We searched PUBMED, Embase and other suitable databases for studies including patients on P2Y12 receptor inhibitors undergoing isolated CABG and reporting bleeding and postoperative ischaemic events from 2013 to March 2024. The primary outcome was incidence of Bleeding Academic Research Consortium type 4 (BARC-4) bleeding defined as any of the following: perioperative intracranial bleeding, reoperation for bleeding, transfusion of ≥5 units of red blood cells, chest tube output of ≥2 l. The secondary outcome was postoperative ischaemic events according to the Academic Research Consortium 2 Consensus Document. Patient-level data provided by each observational trial were synthesized into a single dataset and analysed using a 2-stage IPD-MA. RESULTS Individual data of 4837 patients from 7 observational studies were synthesized. BARC-4 bleeding, 30-day mortality and postoperative ischaemic events occurred in 20%, 2.6% and 5.2% of patients. After adjusting for EuroSCORE II and cardiopulmonary bypass time, guideline-conforming withdrawal was associated with decreased BARC-4 bleeding risk in patients on clopidogrel [adjusted odds ratio (OR) 0.48; 95% confidence intervals (CI) 0.28–0.81; P  = 0.006] and a trend towards decreased risk in patients on ticagrelor (adjusted OR 0.48; 95% CI 0.22–1.05; P  = 0.067). Guideline-conforming withdrawal was not significantly associated with 30-day mortality risk (clopidogrel: adjusted OR 0.70; 95% CI 0.30–1.61; ticagrelor: adjusted OR 0.89; 95% CI 0.37–2.18) but with decreased risk of postoperative ischaemic events in patients on clopidogrel (clopidogrel: adjusted OR 0.50; 95% CI 0.30–0.82; ticagrelor: adjusted OR 0.78; 95% CI 0.45–1.37). BARC-4 bleeding was associated with 30-day mortality risk (adjusted OR 4.76; 95% CI 2.67–8.47; P  < 0.001). CONCLUSIONS Guideline-conforming preoperative withdrawal of ticagrelor and clopidogrel was associated with a 50% reduced BARC-4 bleeding risk when corrected for EuroSCORE II and cardiopulmonary bypass time but was not associated with increased risk of 30-day mortality or postoperative ischaemic events. [ABSTRACT FROM AUTHOR]

Published
2024
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39. The valuable role of cardio-pulmonary exercise testing in the diagnosis of atrial septal defect in a competitive triathlete: a case report.

Author

Sareban, Mahdi, Treff, Gunnar, Wuppinger, Thomas, Zimpfer, Daniel, and Niebauer, Josef

Subjects
ATRIAL septal defects, EXERCISE tests, CARDIAC hypertrophy, MAGNETIC resonance imaging, OXYGEN consumption
Abstract

Background Atrial septal defect (ASD) is characterized by a diverse clinical presentation influenced by the type, size, and haemodynamics. Endurance athletes with ASD may exhibit higher than normal performance levels, however they face an elevated risk of exercise-induced cardiac volume and pressure strain, potentially expediting a maladaptation of the right heart. Case summary An asymptomatic 28-year-old female elite triathlete sought a pre-participation sports medical examination. Her past medical history revealed right heart enlargement. Transthoracic echocardiography and magnetic resonance imaging did not ascertain a definitive diagnosis such as shunting. The examination revealed a remarkably high maximum oxygen uptake during cardio-pulmonary exercise testing (CPET), yet an abnormal oxygen uptake/workload slope and a low, plateauing oxygen pulse. The athlete agreed to transoesophageal echocardiography that demonstrated a superior sinus venosus-type ASD. Surgical intervention, conducted with minimally invasive endoscopic robotic technology and a pericardial patch, was performed at a tertiary centre under full cardio-pulmonary bypass. At seven-month follow-up, the patient reported engaging in swim sessions without limitations and participating in high intensity cycling sessions with performances similar to pre-surgery. Cardio-pulmonary exercise testing revealed increased maximum oxygen consumption and normalization of oxygen uptake/workload slope and maximum oxygen pulse. Discussion Endurance athletes with ASD may have abnormal haemodynamic response during CPET despite an exceptional high maximum oxygen uptake. This underscores the value of CPET in the diagnostic work-up of right heart enlargement. [ABSTRACT FROM AUTHOR]

Published
2024
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48. Hemolysis Index Correlations with Plasma-Free Hemoglobin and Plasma Lactate Dehydrogenase in Critically Ill Patients under Extracorporeal Membrane Oxygenation or Mechanical Circulatory Support—A Single-Center Study.

Author

Zapletal, Bernhard, Zimpfer, Daniel, Schlöglhofer, Thomas, Fritzer-Szekeres, Monika, Szekeres, Thomas, Bernardi, Martin H., Geilen, Johannes, Schultz, Marcus J., and Tschernko, Edda M.

Subjects
*ARTIFICIAL blood circulation, *BLOOD lactate, *EXTRACORPOREAL membrane oxygenation, *LACTATE dehydrogenase, *CRITICALLY ill
Abstract

Monitoring for thrombosis and hemolysis is crucial for patients under extracorporeal or mechanical circulatory support, but it can be costly. We investigated correlations between hemolysis index (HI) and plasma-free hemoglobin (PFH) levels on one hand, and between the HI and plasma lactate dehydrogenase (LDH) levels on the other, in critically ill patients with and without extracorporeal or mechanical circulatory support. Additionally, we calculated the cost reductions if monitoring through HI were to replace monitoring through PFH or plasma LDH. In a single-center study, HI was compared with PFH and plasma LDH levels in blood samples taken for routine purposes in critically ill patients with and without extracorporeal or mechanical circulatory support. A cost analysis, restricted to direct costs associated with each measurement, was made for an average 10-bed ICU. This study included 147 patients: 56 patients with extracorporeal or mechanical circulatory support (450 measurements) and 91 patients without extracorporeal or mechanical circulatory support (562 measurements). The HI correlated well with PFH levels (r = 0.96; p < 0.01) and poorly with plasma LDH levels (r = 0.07; p < 0.01) in patients with extracorporeal or mechanical circulatory support. Similarly, HI correlated well with PFH levels (r = 0.97; p < 0.01) and poorly with plasma LDH levels (r = −0.04; p = 0.39) in patients without extracorporeal or mechanical circulatory support. ROC analyses demonstrated a strong performance of HI, with the curve indicating excellent discrimination in the whole cohort (area under the ROC of 0.969) as well as in patients under ECMO or mechanical circulatory support (area under the ROC of 0.988). Although the negative predictive value of HI for predicting PFH levels > 10 mg/dL was high, its positive predictive value was found to be poor at various cutoffs. A simple cost analysis showed substantial cost reduction if HI were to replace PFH or plasma LDH for hemolysis monitoring. In conclusion, in this cohort of critically ill patients with and without extracorporeal or mechanical circulatory support, HI correlated well with PFH levels, but poorly with plasma LDH levels. Given the high correlation and substantial cost reductions, a strategy utilizing HI may be preferable for monitoring for hemolysis compared to monitoring strategies based on PFH or plasma LDH. The PPV of HI, however, is unacceptably low to be used as a diagnostic test. [ABSTRACT FROM AUTHOR]

Published
2024
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50. Paediatric aortic valve replacement using decellularized allografts: a multicentre update following 143 implantations and five-year mean follow-up.

Author

Horke, Alexander, Bobylev, Dmitry, Avsar, Murat, Cvitkovic, Tomislav, Meyns, Bart, Rega, Filip, Hazekamp, Mark, Cesnjevar, Robert, Schmiady, Martin, Staebler, Brigitte, Dewald, Oliver, Ciubotaru, Anatol, Michel-Behnke, Ina, Zimpfer, Daniel, Jashari, Ramadan, Boethig, Dietmar, Cebotari, Serghei, Beerbaum, Philipp, Tudorache, Igor, and Sarikouch, Samir

Subjects
AORTIC valve transplantation, PEDIATRICS, CHILD patients, CARDIOPULMONARY bypass, AORTIC valve diseases, HOMOGRAFTS
Abstract

Open in new tab Download slide OBJECTIVES Decellularized aortic homografts (DAH) were introduced in 2008 as a further option for paediatric aortic valve replacement (AVR). METHODS Prospective, multicentre follow-up of all paediatric patients receiving DAH for AVR in 8 European centres. RESULTS A total of 143 DAH were implanted between February 2008 and February 2023 in 137 children (106 male, 74%) with a median age of 10.8 years (interquartile range 6.6–14.6). Eighty-four (59%) had undergone previous cardiac operations and 24 (17%) had undergone previous AVR. The median implanted DAH diameter was 21 mm (interquartile range 19–23). The median operation duration was 348 min (227–439) with a median cardiopulmonary bypass time of 212 min (171–257) and a median cross-clamp time of 135 min (113–164). After a median follow-up of 5.3 years (3.3–7.2, max. 15.2 years), the primary efficacy end-points peak gradient (median 14 mmHg, 9–28) and regurgitation (median 0.5, interquartile range 0–1, grade 0–3) showed good results but an increase over time. Freedom from death/explantation/endocarditis/bleeding/thromboembolism at 5 years were 97.8 ± 1.2/88.7 ± 3.3/99.1 ± 0.9/100 and 99.2 ± 0.8%, respectively. Freedom from death/explantation/endocarditis/bleeding/thromboembolism at 10 years were 96.3 ± 1.9/67.1 ± 8.0/93.6 ± 3.9/98.6 ± 1.4 and 86.9 ± 11.6%, respectively. In total, 21 DAH were explanted. Seven were replaced by a mechanical AVR, 1 Ross operation was performed and a re-do DAH was implanted in 13 patients with no redo mortality. The calculated expected adverse events were lower for DAH compared to cryopreserved homograft patients (mean age 8.4 years), and in the same range as for Ross patients (9.2 years) and mechanical AVR (13.0 years). CONCLUSIONS This large-scale prospective analysis demonstrates excellent mid-term survival using DAH with adverse event rates comparable to paediatric Ross procedures. [ABSTRACT FROM AUTHOR]

Published
2024
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